NEW ANC GUIDELINE TRAINING

Dr. Iyayu Nega(MD,GYN/OBS)

5/11/2015
 CONTENTS
• Introduction
• Primary clinical and public health outcomes
of interest to the guideline
• Key Principles of Antenatal Care
• Principles of Preconception Care as a Basis
for ANC
• Maternal and fetal assessment
 ANC IS
• best health conditions for both mother and
baby during pregnancy
• the continuum of maternity care
• include: risk identification, prevention and
management of pregnancy-related or
concurrent diseases, health education and
health promotion.
• opportunity for reproductive health service
integration
 CONT…

• intervention to end preventable maternal and

perinatal mortality and morbidity
• make pregnancy a healthy and positive
experience for a woman and her family
• the FANC model was associated with more
adverse events, especially increased perinatal
mortality.
 CONT…
• The maternal mortality ratio (401/100,000 live
births) and neonatal mortality rate (33/1000
live births) in Ethiopia are among the highest
in the world and Ethiopia adopted the 2016
WHO model of eight contacts to reduce
maternal and perinatal mortality and
morbidities.
Primary clinical and public health outcomes
of interest to the guideline
A. Maternal outcomes:
• Increased maternal and family satisfaction
with ANC services provided Universal
screening of Hb/Hct, blood group and RH, HIV,
syphilis, hepatitis B virus (HBV), urinalysis and
tuberculosis is instituted in all health facilities
• Pregnancy-related nutritional problems (under
and over nutrition) are prevented and/or
corrected
 CONT…
• Common pregnancy-related conditions are
prevented or detected early and treated
• Pregnant women are counseled to have safe
and successful pregnancy outcomes
• Pregnant women are counseled on
postpartum family planning
 CONT…
B. Fetal and neonatal outcomes:
• Preventable early pregnancy losses are prevented
and associated complications are managed
• Congenital anomalies are prevented and
pregnancies with congenital anomalies are
managed timely
• Fetuses with problems are timely detected and
delivered in a setting where neonatal care is
optimal
 CONT…

• Premature deliveries due to preventable

causes are reduced
• Perinatal mortality is reduced
• Mother-to-child transmissions of HIV, syphilis,
and HBV during pregnancy, delivery, and
lactation are eliminated
 CONT…
C. Health system outcomes:
• Quality of ANC is improved
• ANC attendees are maintained in the
continuum of care with increase in ANC,
skilled birth attendance and postpartum care
coverage with reduced dropout
 Key Principles of Antenatal Care
• Implementing the new ANC model of eight
contacts schedule
• ANC care should be woman-centered
• De-medicalized ANC
• ANC should be providing efficient and timely
care
• ANC should be evidence-based
 CONT…
• ANC should be multidisciplinary
• ANC should be holistic
• ANC should respect the privacy, dignity, and
confidentiality of women.
• ANC providers should be motivated,
competent, and compassionate.
• Women with special needs require care in
addition to the core components of basic care
Principles of Preconception Care as a Basis
for ANC
A. Assessment:
• Potentially recurring obstetric complications
experienced during previous pregnancies:
recurrent pregnancy loss, preterm labor, pre-
eclampsia/eclampsia, gestational diabetes,
congenital anomaly, puerperal psychosis
• Obstetric and gynecologic surgery: operative
delivery, cerclage, loop electrosurgical excision
procedure (LEEP), cone biopsy, myomectomy
• Immunologic disorders: autoimmune diseases
 CONT…
• Medical and mental health disorders: diabetes
mellitus, thyroid disorders, hypertension,
anemia, deep vein thrombosis, asthma,
epilepsy, depression, anxiety disorder, etc.
• Infectious diseases: sexually transmitted
infections (STIs) including HIV, gonococcal,
chlamydial; hepatitis virus other infectious
disease like malaria and tuberculosis.
• Physical disability and developmental disorders
 CONT…
B. Interventions:
• Counseling on the risk of pregnancy with uncontrolled medical
conditions (anemia, DM, cardiac disease, renal disease,
hypertension, etc.) and substance use
• Counseling and providing appropriate contraception for those
not desiring pregnancy or until chronic medical conditions are
stabilized
• Promoting micronutrient supplementation (iron, folic acid,
calcium), promote consumption of fortified and biofortified
foods, diversified and nutrient-dense foods
• Monitoring weight gain during pregnancy, body weight
adjustment (overweight and obese; underweight)
 CONT…
• Counseling on the increased risk to the fetus (including
neural tube defects) of using alcohol and illicit drugs
immediately after conception and throughout
pregnancy
• Counseling women at increased risk of having a fetus
with a neural tube defect (those who gave birth a baby
with a neural tube defect, women taking antiepileptics,
and diabetics) to take high-dose supplementation of
folic acid and be advised to increase their food intake of
folate
• Providing pre-pregnancy vaccination (Td for all)
 CONT…
• Counseling on lifestyle modification (avoiding use of
substances, including alcohol, tobacco, khat, illicit
drugs; limiting caffeine intake; avoiding exposure to
environmental hazards)
• Adjusting medications: using relatively safe medicines
and discontinuing drugs contraindicated during
pregnancy like (ACE) inhibitors, isotretinoin (Accutane),
and some anticonvulsant therapy like hydantoin or
valproic acid]
• Counseling on the increased risk of carrying a fetus with
a chromosomal abnormality after the age of 35 years
 CONT..
C. Socioeconomic status
• Assessing vulnerability to domestic violence,
social discrimination and stigma, and ensuring
linkages to locally available services
Maternal and fetal assessment at first ANC
contact
• History and physical examination
• Hemoglobin (Hb) or hematocrit (Hct), blood
group, and Rh
• Urine analysis: dipstick, microscopy and gram
stain
• Tests for HIV, HBV, syphilis
• Ultrasound before 24 weeks
CONT…
CONT…
CONT…
 Recommended food groups for pregnant womenat least five out of ten

1. Grains, white roots and tubers, and plantains (“starchy

staples”)
2. Pulses (beans, peas, and lentils)
3. Nuts and seeds
4. Dairy
5. Meat, poultry, and fish
6. Eggs
7. Dark-green leafy vegetables
8. Other vitamin A-rich fruits and vegetables
9. Other vegetables
10. Other fruits
 Pre-exposure prophylaxis for HIV
prevention
Taking an antiretroviral for pre-exposure prophylaxis (PrEP)
is highly recommended when there is a substantial risk of
acquiring HIV. The target beneficiaries for PrEP service are:
• Consenting HIV negative female sex workers
• HIV negative partners of sero-discordant couples
• HIV negative pregnant and breastfeeding women at
substantial risk of HIV infection during antenatal and
postnatal follow-up visits with HIV-positive partner,
which also required conducting routine partner testing
for HIV
Health Systems Interventions to Improve the Utilization
and Quality of Antenatal Care